Woodside Farm House

Woodside Farm House is a care home for up to eight people with a learning disability and autistic people. At the time of the inspection there were seven people living in the service. Three people were living in self-contained accommodation at the rear of the main house. Woodside Farm House is part of the Potens group, a national provider of health and social care support services for children and adults with disabilities and complex 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 statutory guidance which supports CQC 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.

Right support:

The model of care and setting maximised people’s choice, control and independence. Woodside Farm House is near to the centre of St Austell town and people had access to the local community and amenities. Staff supported people to make choices about their daily lives and engage in activities, that were tailored to their individual needs and promoted their independence. People were supported to maintain and develop relationships.

Right care:

People received good quality person-centred care that promoted their dignity, privacy and human rights. There was a strong person-centred culture within the staff team. Positive behaviour support plans had been developed for people, to help staff understand the reasons for their behaviour, and provide guidance to ensure consistent approaches were used when supporting people. Staff knew people well and demonstrated an understanding of people’s individual care, behavioural and communication needs. This helped ensure people people’s views were heard and their diverse needs met.

Right culture:

The ethos, values, and attitudes of management and care staff ensured people led confident, inclusive and empowered lives. Staff created an environment that inspired people to understand and achieve their goals and ambitions.

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

The registered manager had identified there were insufficient numbers of permanent staff to cover all shifts. Therefore, they had block booked specific agency staff members to cover the vacant shifts. This ensured shifts were covered by consistent staff. Enough staff were employed each day to meet people's needs, keep them safe and give them the opportunity to take part in their chosen activity.

Medicines were administered and managed safely. Some people were prescribed 'as required' medicines for pain relief or to help them to manage anxiety. Records evidenced that when these medicines were prescribed there was involvement from health and social care professionals as to in what situations and when these medicines should be administered and how they should be reviewed. The organisation agreed they would remind staff of the STOMP (Stopping Over Medication of People with a Learning Disability) principles for the use of certain medicines.

Some ‘as required’ protocols were not dated and therefore staff would not be assured that this was the most up to date guidance and would not be aware when it was due to be reviewed. The registered manager agreed to address this immediately.

People were offered choice and control and where able, consented to their care and support. Pictures and photographs were used to facilitate effective communication. Staff supported people to be as independent as possible with activities of daily living, such as laundry, cooking, shopping and personal care. People were supported to take part in community activities of their choice and interest.

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.

Staff’s knowledge of how people communicated ensured people had maximum control over their lives and how they spent their time. Care and behaviour support plans were accurate and kept under regular review, with the involvement of the person and their family. They provided staff with comprehensive guidance to ensure people’s needs were met. Risks were identified and staff had clear instructions to help them support people to reduce the risk of avoidable harm.

Staff were recruited safely. Staff were supported by a system of induction, training, supervisions, appraisals and staff meetings. Staff were appropriately trained, and their competency regularly checked, to ensure people’s complex needs were met.

Cleaning and infection control procedures had been updated in line with COVID-19 guidance to help protect people, visitors and staff from the risk of infection. Government guidance about COVID-19 testing for people, staff and visitors was being followed.

People’s relatives and staff told us management were approachable and they listened to them when they had any concerns or ideas. All feedback was used to make continuous improvements to 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 9 August 2021).

Why we inspected

We undertook this focused inspection to check on specific concerns we had about the service. We received concerns in relation to staffing levels and the impact this had on the quality of care and support that was being provided. We also received some concerns about medicines. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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 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.

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.

Woodside Farm House is a care home for up to eight people with a learning disability and autistic people. At the time of the inspection there were eight people living in the service. Two people were living in self-contained accommodation at the rear of the main house. Woodside Farm House is part of the Potens group, a national provider of health and social care support services for children and adults with disabilities and complex needs.

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

The service was clean and there were additional cleaning procedures in place to limit infection control risks within the service. Covid-19 testing had been regularly completed.

Staffing levels were appropriately managed, and people received care from consistent, regular staff. Enough staff were employed each day to meet people's needs, keep them safe and give them the opportunity to take part in their chosen activity.

People were offered choice and control and where able, consented to their care and support. Pictures and photographs were used to facilitate effective communication. Staff supported people to be as independent as possible with activities of daily living, such as laundry, cooking, shopping and personal care. People were supported to take part in community activities of their choice and interest. Where people had capacity, they used public transport and went into the wider community independently.

The leadership of the service promoted a positive culture that was person-centred and inclusive. We received positive feedback about the quality of care and support people received and the overall management of the service from their relatives. The registered manager and the staff team showed a desire to continue to improve on the service provided and in turn the quality of life experiences for the people at Woodside Farm House.

Medicines were administered and managed safely. Staff maintained accurate medicines administration records. The environment was safe and clean.

There were systems in place for staff to learn lessons when things go wrong.

People's care needs were assessed, and their support planned based on their individual needs and choices. Care plans were reviewed regularly to ensure support delivered to people continued to meet their needs.

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.

People received food and drink to meet their nutritional and dietary needs. People received support to maintain good health; and staff worked effectively with health and social care professionals.

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 statutory guidance which supports CQC 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.

Right Support:

People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Right Care:

People received good quality person-centred care that promoted their dignity, privacy and human rights. There was a strong person-centred culture within the staff team.

Right Culture:

People lived in a service where the ethos, values, and attitudes of management and care staff ensured people led inclusive and empowered lives. People were supported in an environment that helped them to achieve realistic goals and ambitions.

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 17 June 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led.

When we inspected the service in April 2021 we found staff were not always wearing surgical face masks. We also identified that COVID-19 checks were not robust for visitors. This was contrary to guidance published by Public Health England and a breach of the regulations.

Following the site visit we sent a letter of intent to take enforcement action and requested an action plan from the provider showing how these concerns would be addressed. The manager provided an appropriate action plan to resolve these issues. The evidence provided us with some reassurance. At this inspection we found the service had taken action to ensure Personal Protective Equipment (PPE) was used in accordance with guidance and visiting protocols had been reviewed and updated.

The ratings from the previous focused 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 required improvement to good. This is based on the findings at this inspection.

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.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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.

Woodside Farm House is a care home for up to eight people with a learning disability and/or autism. At the time of the inspection there were seven people living in the service. Three people were living in self-contained accommodation at the rear of the main house. Woodside Farm House is part of the Potens group, a national provider of health and social care support services for children and adults with disabilities and complex needs.

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

We found staff were not always wearing surgical face masks. We also identified that COVID-19 checks were not robust for visitors. This was contrary to guidance published by Public Health England and a breach of the regulations. We raised this failing with the manager during the inspection and with the provider.

Following the site visit we sent a letter of intent to take enforcement action and requested an action plan from the provider showing how these concerns would be addressed. The manager provided an appropriate action plan to resolve these issues. The evidence provided us with some reassurance.

The service was clean and there were additional cleaning procedures in place to limit infection control risks within the service. Covid-19 testing had been regularly completed.

There was a relaxed and friendly atmosphere at the service. People said they felt safe and well cared for.

People were supported to be as independent as possible and have control over their lives. People's dignity was respected, and staff encouraged and supported people to make decisions and choices about how they spent their time.

Staff understood their role in protecting people from harm or possible abuse. Accidents and incidents had been investigated to identify areas of learning and prevent similar incidents from being repeated. Medicines were managed safely.

Records of people's care were individualised and detailed their needs and preferences.

Staff were recruited safely. The manager was actively recruiting more care staff. However, staffing levels were in sufficient numbers to ensure people’s needs were met.

People and their relatives were involved in decisions about people’s care and kept informed of any changes to the running of the service. People, their relatives and staff told us the management were approachable and listened when any concerns or ideas were raised.

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.

Right support:

The model of care and setting gave people the opportunity to exercise their choice, control and independence. People were supported to understand and exercise their right to experience the wide range of opportunities that most people take for granted.

Right care:

People received person-centred support to live meaningful and active lives. The support people received from staff promoted their dignity, privacy and human rights. People's needs and preferences were known and respected.

Right culture:

The ethos, values, attitudes and behaviours of staff working at Woodside farm house ensured people using the service led confident, inclusive and empowered lives. People were empowered to have choice and control over their lives.

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

Rating at last inspection and update

The last rating for this service was requires improvement. (Report published on 29 November 2019). We carried out an unannounced inspection of this service on 6 November 2019. A breach of legal requirement was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve Good Governance. At this inspection we found enough improvement in the area of Good Governance so that the provider was no longer in breach of this regulation.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

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 remained require improvement. This is based on the findings at this inspection.

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.

At this inspection we found the provider was not consistently following Public Health England guidance and therefore the provider was in breach of regulation of Safe care and treatment.

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

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Woodside Farm House is a care home for up to eight people with a learning disability and/or autism. At the time of the inspection seven people were living at the service. Three people were living in self-contained accommodation at the rear of the main house. Woodside Farm House is part of the Potens group, a national provider of health & social care support services for children and adults with disabilities and complex needs.

The service was developed and designed before the introduction of 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. The provider and management team were aware of the guidance and worked to support people in line with the principles. 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

Medicines prescribed for regular use were administered according to prescriptions and clearly recorded. Those medicines intended to be used when required, for example for pain relief or to help people when they were anxious were not consistently recorded.

We have made a recommendation about the management of some medicines.

Care plans were detailed and clearly guided staff on how people should be supported in all areas of their lives. These were reviewed regularly although we identified some examples where the review process had not been robust. Some supporting information was out of date or incomplete.

Audits to ensure robust record keeping which reflected people’s needs had failed to identify the issues in recording the use of medicines to be used as required or the shortcomings in other records identified in this report.

There were enough staff to support people safely and enable them to go out when they wanted. Any gaps in the rota were covered by agency staff. These staff usually knew people well and were familiar with the service. Permanent staff told us it could be difficult when agency staff were new to the service and, at these times, people were not always supported according to guidelines in place. The acting manager told us they would address this problem.

Risks to people’s safety, health and emotional well-being were well known and risk assessments had been completed to inform staff on how risks could be mitigated. These were reviewed and updated as people’s needs changed.

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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People living at Woodside Farm House had complex needs and could become distressed and anxious at times. Staff had a good understanding of each person’s needs and knew how they preferred to be supported. They understood what might lead to people becoming distressed and how to avoid these triggers. When incidents occurred staff and management reflected on the circumstances surrounding the event to see if any lessons could be taken from it to improve people’s experience in the future. Staff received de-briefs to support their own learning.

Training was provided which focused on people’s individual needs as well as training identified as necessary for the service. Staff were supported by a system of supervision and staff meetings.

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 (report published 19 May 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to auditing systems and record keeping at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

There was a registered manager in post. A registered manager is a person who has registered with the 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.

People told us they felt safe living at Woodside Farm House and they liked the staff. Relatives also told us they felt people were well cared for and safe. This view was echoed by the health and social care professionals we spoke with. Staff knew how to help protect people if they suspected they were at risk of abuse or harm. The service kept people’s personal monies for them and accurate records of all expenditures. Risks to people's health, safety and wellbeing had been assessed. Staff knew how to minimise risks in order to help keep people safe from harm or injury.

Some people could become distressed or anxious at times and found this difficult to cope with. When they were particularly anxious they could act in a way which could put themselves or others at risk of harm. Staff were aware of how to support people appropriately at these times to help keep them safe and well.

There were sufficient numbers levels of staff to meet people's needs. Staff were deployed effectively across the service to help ensure all people’s needs were met quickly. Rotas were flexible to enable people to take part in activities which fell outside of normal shift patterns.

People received their medicines appropriately and as prescribed. Systems for recording the administration and stock of medicines held at the service were not robust. We have made a recommendation about this in the report.

People were assessed in line with the Deprivation of Liberty Safeguards (DoLS) as set out in the Mental Capacity Act 2005 (MCA). DoLS provide legal protection for vulnerable people who are, or may become deprived of their liberty. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals when appropriate. Records showed applications for DoLS were being made appropriately and some people had DoLS authorisations in place. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff demonstrated an enthusiasm for their work and a genuine fondness for the people they supported. They spoke of people positively and emphasised their attributes and qualities when describing people to us. One person was going through a particularly difficult time and staff were sympathetic and understanding towards them and displayed a concern for their well-being.

People were supported according to their individual needs and preferences. Although people sometimes liked to spend time with each other they also enjoyed taking part in individual activities to suit their own pace. Staff had access to four vehicles and were able to plan people’s days to reflect their interests. Some people were able to use public transport in order to access the local community.

There were clear lines of responsibility in place. The registered manager was supported by a deputy who had a good working knowledge of the day to day running of the service. The registered manager had oversight of the service and staff told us she was approachable and had a good understanding of the service. There was a key worker system in place. Key workers are members of staff with responsibility for the care planning for a named individual.

People who lived at Woodside Farm House were happy with the support they received and thought the staff were 'good'.

Staff at Woodside Farm House engaged with people to ensure they were able to give meaningful consent for the care and support they received.

Staff said although they received a lot of training they would like more specific training so they could support one person more effectively.

There was an effective quality assurance procedure in place.

Care records showed people were given information to help them make decisions for themselves where possible, and we found people's privacy, dignity and independence were respected and upheld. We saw people's wishes were respected.

Care plans and associated documentation provided sufficient detail to directe and guide staff on the action they needed to take in order to meet people's assessed care needs. People's records were personalised and provided clear information about the person's wishes and abilities.

People were protected from abuse and staff were trained and supported to carry out their roles.

The home was clean throughout at the time of the inspection.