This inspection took place on 28 and 30 September 2016 and was unannounced.Woodbury provides residential care for up to 14 people on a permanent basis and also has one bed available for respite care. It provides care for people who have learning disabilities and/or physical disabilities, including people with autism spectrum disorders, epilepsy and mental health needs. At the time of our inspection 14 people were using the service on a permanent basis and another person visited for respite care on the second day of our inspection.
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.
At our last comprehensive inspection in November 2015 we gave the service a ‘requires improvement’ rating. We followed up our concerns about insufficiently robust risk assessment, risk management and audit systems at a focused inspection in January 2016 and found they had all been addressed. We also found in November 2015 that the provider was breaching the regulation in regards to safe staffing, because there were not enough staff deployed on shifts to keep people safe. We did not follow this up in January 2016 because not enough time had passed for the service to demonstrate improvement in this area.
At this inspection, we found the provider had increased staffing levels and carried out an assessment of people’s needs with regard to staffing levels. We saw there were enough staff to care for people safely.
People told us they enjoyed living at Woodbury. One person said it was “very good.” Another person said, “I like it here. I have friends here.” A third person told us, “I like it. It’s a nice place and I have my own room.” People felt safe using the service, were able to report concerns and staff knew how to recognise and report abuse. Managers followed appropriate procedures to follow up allegations of abuse. Robust procedures were in place to help ensure that unsuitable staff were not recruited to work with people.
There were systems in place to identify and manage risks to people’s safety in proactive ways that did not unnecessarily restrict people’s freedom. This covered both general risks posed by the environment and risks that were specific to individuals. Risk assessments were personalised and regularly updated. Staff had opportunities to discuss safety concerns and the registered manager used systems to collate information about accidents, incidents and concerns so they could identify any trends and monitor risks to people’s safety.
Medicines were stored, handled and administered safely. Although the service had reported a number of medicines errors during the year before our visit, the provider had identified this and put measures in place to prevent errors from happening and to ensure that errors were quickly identified and dealt with appropriately.
Staff received the supervision, support and training they required to perform their roles effectively. This included special training in response to feedback from outside professionals about staff knowledge. The provider enlisted healthcare and other professionals to provide specialist training to ensure staff were up to date with current best practice in supporting people with their specific needs. Healthcare professionals told us staff were good at following professional advice and meeting people’s healthcare needs. Staff supported people to access healthcare and other services when needed and people had personalised plans to help staff provide them with the care and support they needed and wanted for their health.
Staff obtained people’s consent before carrying out care tasks. Care plans contained information to help staff do all that was reasonably possible to help people understand the information they needed to consent to their care. If people did not have the capacity to consent, the provider followed the processes that are legally required by the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) to ensure that decisions made about people’s care, including any restrictions on their freedom, were made in their best interests and did not compromise their rights.
People received a variety of nutritious food and drinks that they enjoyed. Staff were aware of people’s specific needs around nutrition, including cultural and religious needs and other dietary requirements, and took action to make sure these were met.
People and relatives fed back that staff were kind and caring. We saw staff interacting with people in a way that was respectful and friendly, although sometimes staff did not talk to people when supporting them to eat which meant they may not have been fully aware of what they were eating or what staff were doing. Staff knew people well and used appropriate methods of communication according to people’s needs, although there was a lack of detailed information about people’s life histories that would help staff understand people better. We recommend that the provider explore life history work with people and, if appropriate, families and others who know people well.
Staff offered people choices about their care, gave them the information they needed to make choices and kept them informed about what was happening. Staff showed respect for people’s privacy, dignity and independence, although people’s personal records were not always stored securely. Managers were in the process of taking action to address this concern.
People had assessments of their needs and these were used to complete personalised care plans. The care plans showed the support people needed to complete everyday tasks and activities, how they preferred to be supported and what was important to them. Care plans were designed to enable staff to support people in a person-centred way. Although some relatives and visiting professionals felt there could be more activities provided, the registered manager was in the process of making improvements to the activities timetable and a number of group and individual activities took place during our inspection. People received support to attend activities and religious services in the community, go on holidays and use the garden at home.
There were systems to ensure that the provider responded appropriately and promptly to concerns and complaints that people and visitors raised. We saw examples of these showing action was taken to resolve any problems and prevent them from happening again.
People, staff and relatives felt the registered manager led the service well. The manager had worked to make the culture of the service more supportive, person-centred and open. Staff told us they had opportunities to express their opinions and the manager listened to them. Roles and responsibilities of staff were clear and staff knew whom to approach for help and support. The manager was aware of challenges faced by the service and told us how they addressed these, such as issues with poor record-keeping. We saw improvements had been made in this area. People, staff and relatives felt the service had improved over the last year and was still getting better. The provider used a range of audits and checks to assess, monitor and improve the quality of the service. Where these identified action to be taken, the registered manager ensured this was done.
There were links with the local community that helped people to feel involved, empowered and valued. The provider worked with other organisations to improve the quality of the service and promote best practice.