Woodcroft

We found some improvements were needed in relation to infection control practices at the service in relation to preventing visitors from catching and spreading infections. Although we were told visitors were asked for evidence of a negative lateral flow device (LFD) test on arrival and their temperature was taken, this did not happen when we arrived. In addition, we were given differing responses to how often staff should carry out LFDs each week. We were assured however, by senior management’s response to this situation.

We found the following examples of good practice:

People who lived at the home were supported to access testing for COVID-19 and to have their COVID-19 vaccinations. If people contracted COVID-19, they were supported to self-isolate in their bedrooms if they were able to do so.

Family visits were planned to ensure there were never multiple visitors in the home simultaneously. If people living at the service had tested positive with COVID-19, visitors were asked to meet with their family member outside. When there were no cases of COVID-19 visitors could come into the service and spend time in communal areas or people’s individual rooms.

Staff took part in a COVID-19 testing regime. Any staff who contracted COVID-19 did not return to work until they had completed an appropriate period of self-isolation.

The premises were clean and staff told us they were aware of the importance of cleaning all surfaces thoroughly. Staff had access to the personal protective equipment (PPE) they needed and had attended training in its use. There were various PPE stations throughout the building.

Woodcroft is a residential care home providing personal care and accommodation to six people with learning disabilities at the time of the inspection. Five of these people lived at Woodcroft and a sixth person who had regular short stays at the service. The service can support up to six people in one building.

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

People were not always safe at Woodcroft. Safeguarding concerns were not always shared with the local authority. We witnessed unsafe moving and handling taking place and risks to people were not always effectively managed. Some infection prevention and control guidance provided by Public Health England were not always followed.

Staff did not always receive the training they required to enable them to support people safely. There were people who were having their liberty restricted at Woodcroft who had not had the appropriate mental capacity assessments, best interest decisions or Deprivation of Liberty Safeguards (DoLS) applied for.

We saw some positive caring interactions between staff and people living at the service, however people were not always treated with respect or dignity. At times people were very limited in the choices they could make for themselves and access to activities for some people was limited.

People had individual communication plans in place and staff had a good understanding of how to communicate with them effectively. However, support plans were missing some important information. One person’s records showed that they had a diagnosis of dementia, however how this may alter their support needs was not mentioned in their care and support plans.

The provider’s quality monitoring processes were not effective at identifying and addressing shortfalls. Health and safety audits took place however there was not an effective system to ensure actions were completed as a result. Audits did not take place to ensure people were receiving their medicines safely. There had been one notifiable incident involving a serious injury to a service user which had not been reported to CQC when necessary.

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.

This service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. 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

Right support:

• People's support needs were not always correctly recorded to ensure they received the most appropriate care. This included information around risks to people and how to maintain their skin integrity.

Right care:

• Care practices did not always uphold or respect people's dignity. We saw examples of punitive responses recorded to address people and observed a lack of respect for people's home.

Right culture:

• The culture in the service was impacting negatively on people's experiences and care support. There was a lack of effective leadership and governance at the service. Systems in place were not being reviewed appropriately to promote positive changes for people.

The provider has acknowledged that improvements needed to be made to people’s care and have agreed to work in conjunction with the local authority and other professionals to improve people’s experience of living at 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 on 9 November 2018).

Why we inspected

The inspection was prompted in part due to concerns received regarding infection control, safeguarding and staffing. A decision was made for us to inspect and examine those risks.

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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, consent for support, good governance, and notification of incidents.

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 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.

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.

At our last inspection of the service on 10 March 2016 the service was rated Good. At this inspection we found the service remained Good. The service demonstrated they continued to meet the regulations and fundamental standards.

People continued to be supported and protected from the risk of abuse or harm. Risks to people’s safety and well-being were assessed and care plans were put into place to manage identified risks whilst ensuring individual’s independence and rights were respected. Accidents and incidents were recorded, managed and monitored safely to assist in reducing the risk of reoccurrence. There were systems in place to deal with emergencies and protect people from the risk of infections. Medicines were stored, managed and administered safely. There were sufficient numbers of staff to ensure people were supported appropriately and promptly when required. Appropriate recruitment checks were conducted before staff started work to ensure they were suitable to be employed in a social care environment.

Staff received an induction when they started work and had on-going support, supervision and training. 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. People were supported to meet their nutrition and hydration needs and had access to health and social care professionals when required. People told us they were consulted about their care and staff treated them with kindness and respect. Care plans and assessments considered the support people required with regard to any protected characteristics they had under the Equality Act 2010. People were involved in day to day decisions about their care and treatment.

People indicated that staff were kind and caring and treated them with respect and dignity. People were involved in making decisions about their care. Staff we spoke with were knowledgeable about the contents of people’s care plans and care plans contained clear guidance for staff on how best to support people to meet their needs and aims. People were supported to participate in activities that were meaningful to them and that met their need for social interaction and stimulation. The registered manager and staff were committed in ensuring people received appropriate support and care at the end of their lives. The provider had a complaints policy and procedure in place which contained guidance for people and their relatives or visitors on what they could expect if they made a complaint.

Staff told us that the registered manager provided them with leadership, support and was always available to them day and night offering guidance when they needed it. The registered manager had notified us of important events that had happened at the service and understood the need to display the rating. There were systems in place that ensured the registered manager and provider took account of the views of people living at the home and their relatives where appropriate. The service worked well with external organisations including health and social care professionals to ensure people’s needs were safely met and to help improve the quality of the service provided. The provider recognised the importance of regularly monitoring the quality of the service and there were systems in place to ensure audits and checks were conducted.

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 and associated Regulations about how the service is run.

Medicines were managed in a safe way and recording of medicines was completed to show people had received the medicines they required.

Staff met with their line manager on a one to one basis to discuss their work. Staff said they felt supported and told us the provider had good management oversight of the home.

People lived in a homely environment and were encouraged to be independent by staff. Staff supported people to keep healthy by providing people with a range of nutritious foods. Everyone was involved in the menu planning and shopping. People had access to external health services and professional involvement was sought by staff when appropriate to help maintain good health.

People were encouraged to take part in a range of activities which were individualised and meaningful for people. We heard people chose what they wished to do on the day.

People had risk assessments in place for identified risks. The registered manager logged any accidents and incidents that occurred and staff responded to these by putting measures in please to mitigate any further accidents or incidents.

Staff had followed legal requirements to make sure that any decisions made or restrictions to people were done in the person’s best interests. Staff understood the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS).

There were a sufficient number of staff on duty to meet people’s needs and support their activities. People and staff interaction was relaxed. It was evident staff knew people well, understood people’s needs and aspirations. Staff were very caring to people and respected their privacy and dignity.

Staff received a good range of training specific to people’s needs. This allowed them to carry out their role in an effective and competent way.

The registered manager and staff undertook quality assurance audits to ensure the care provided was of a standard people should expect. Any areas identified as needing improvement were actioned by staff.

If an emergency occurred or the home had to close for a period of time, people’s care would not be interrupted as there were procedures in place.

Appropriate checks, such as a criminal record check, were carried out to help ensure only suitable staff worked in the home. Staff were aware of their responsibilities to safeguard people from abuse and were able to tell us what they would do in such an event and they had access to a whistleblowing policy should they need to use it.

A complaints procedure was available for any concerns. This was displayed in a format that was easy for people to understand. People and their relatives were encouraged to feedback their views and ideas into the running of the home.

People who lived in the service told us they liked living there and felt safe. They told us if they were worried about something they knew who to talk to. We saw safeguarding procedures were in place and staff told us they had undertaken training regarding these procedures. During discussion with staff they demonstrated how to safeguarded people they supported.

People's health care needs were discussed with them and we saw how these were managed in health action plans. People were able to visit their GP and we saw one person required the support of an advocate when accessing dental care to ensured they understood what was involved.

Staff told us they enjoyed working in the home and felt they had the training and support required to undertake their roles. They told us additional training was provided when people's needs changed. For example the manager responded with additional manual handling training and behaviour awareness training for staff to ensure they were able to provide safe and appropriate care for people to support their changing needs. People knew how to make a complaint but said they did not have to complain recently. We saw the complaints procedure in place that would be followed to respond to a complaint being made.

We found the service was well managed and and both staff and people who used the service felt well supported by the management structure in place. Systems were in place to manage the quality of service provision that included regular auditing, provider visits and feedback surveys. This ensured the service identified shortfalls and made adjustments to continue to improve.

We observed staff interacting with people in an inclusive and respectful way. Two people who used the service told us that they liked to help in the kitchen and were able to wash up.

We observed that people looked comfortable and relaxed in the home and were confident in their surroundings.

People told us that they liked the activates arranged by the home. They told us that they had been involved in planning some of the activities. People told us that they attended and enjoyed going to a variety of day centres. They also told us that they had planned holidays for this year with the staff.

Staff told us that they enjoyed working in the home and said that there was ample training available to enable them to undertake their roles.

Staff had a good understanding of people's needs. They told us that they had undertaken venerable adults training known as safeguarding. They were able to describe the signs to look out for and would have no hesitation in reporting any incidents of abuse or bad practice to their manager.