This inspection took place on 31 may and the 1 June 2018 and was unannounced. At our last inspection on 09 February 2017, the service was rated requires improvement with a breach of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. This was because the provider had not insured people were safe from risks to their health and welfare associated with the way that medicines were managed. At this inspection, we found that the provider had taken the required action to address these shortfalls and were meeting the required standards.

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. However, we noted that further improvements were required.

Royal Mencap Society – Woodlands Residential Home is a residential care home that provides accommodation, care and support for up to eight young people living with a learning disability. There were eight people living at the home at the time of this inspection.

The home consisted of one large detached Bungalow. Each person had their own personalised bedroom with en-suite facilities, In addition to its eight bedrooms; the spacious property has two bathrooms, kitchen, lounge, dining room, conservatory and laundry room. The manager’s office is located within the bungalow. The home is conveniently located about fifteen minute walk to the town.

There was not a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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. The manager had made an application to register with CQC.

There were policies and procedures in place to protect people from the risk of infections. However, there were no cleaning schedules to ensure infection control was maintained.

People had access to the community and were supported with activities. However, we found that more involvement was required to ensure people's interest and goals were supported

When care plans were updated with changes to people's support needs old documentation had not been removed.

People`s medicines were managed safely by staff who had their competencies assessed.

People felt safe living in the home and staff received appropriate training in how to keep people safe.

Staff received training and appropriate support from the managers to carry out their roles effectively.

There were enough staff employed through robust recruitment procedures to meet people`s needs effectively.

People and families where appropriate were involved in the development and review of their care and support,

People were involved in daily tasks around the home like cleaning, laundry, cooking and baking. Staff supported people to access the community.

We observed people enjoying their food and staff offered people choices.

People and staff were positive about the management of the service. There were systems in place to ensure the quality of the service was monitored and improved where required.

The inspection took place on 9 February and was unannounced.

Royal Mencap Society - Woodlands Residential Home provides accommodation and personal care for up to eight people with a learning disability who may also have a physical disability. Each person has their own room and all of the facilities are on one level. At the time of our inspection there were eight people living in the home.

At our last inspection in January 2016, the service was in breach of two of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. The use of listening devices in people's bedrooms, broadcasted to communal areas, compromised people's privacy and dignity. The principles of the Mental Capacity Act 2005 were not being followed in relation to seeking consent. After that inspection, the registered persons sent us an action plan explaining what they would do to improve. At this inspection, we found that they had taken the necessary action to comply with these regulations and were no longer in breach.

People's capacity to make specific decisions about their care and treatment was assessed properly and, if they were not able to make the decision, their best interests were taken into account. In relation to listening devices, there was better assessment of people's awareness of risks associated with epilepsy and work with a professional to consider essential aspects of people's safety. They were only used for short periods when they were essential and receivers were not used within communal areas. The service was looking at further developments in technology to see if there were alternatives that would further improve the way people were supported.

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.

We noted that, during the course of 2016, the registered manager for this home was seconded elsewhere to another of the provider's services. Another manager was allocated to oversee the service but not registered in respect of it. When the registered manager returned to the home, the deputy manager was seconded elsewhere, again to oversee another of the provider's services. This meant that management of the service had not been entirely consistent. Staff were looking forward to a period of more stability and continuity following the registered manager's return to the service, together with the assistant service manager.

Most systems for monitoring the quality and safety of the service were working well. However, monitoring systems associated with the management of medicines had not been sustained during 2016. Processes for monitoring the management of medicines were not robust enough. Thorough checks were not made regularly to ensure that concerns about medicines were identified and followed up promptly. The provider's quality assurance processes had not addressed this issue to ensure improvements were made.

We found that medicines were not always managed safely and in a way that ensured people received them in the way the prescriber intended. Creams or lotions for external use were not always used as their prescriptions showed they should be. These products were not always dated when they were opened so that staff could be sure they remained free from contamination, safe and effective to use.

There were enough staff who were competent to support people safely and robust recruitment processes contributed to protecting people from the risk of harm or abuse from staff who were not suitable to work in care. Staff understood their responsibilities to report if they had any concerns that people were at risk of harm or abuse and how to go about this. They also understood the risks to which people were exposed in

This inspection was unannounced and took place on 26 January 2016.

Royal Mencap Society Woodlands Residential Home is registered to provide accommodation and personal care for up to eight people who are living with learning and physical disabilities. At the time of our inspection there were eight people living at the home.

There was a registered manager in place. 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 an understanding of abuse and safeguarding procedures. They were aware of how to report abuse as well as an awareness of how to report safeguarding concerns outside of the service. Staff undertook safeguarding training providing them with knowledge to protect people from the risk of harm.

The provider had a robust recruitment procedure in place. People were supported by staff who had only been employed after the provider had carried out checks. Staff were well trained and supported by the registered manager. There were sufficient numbers of staff to meet people’s needs safely.

Risks were identified through a range of comprehensive individual risk assessments to help keep people safe. Care plans were up to date, person centred and detailed in order that staff could support people in the way that they liked to be supported.

People’s health, care and nutritional needs were effectively met. People were provided with a varied and balanced diet. Staff referred people appropriately to healthcare professionals in a timely manner when their support needs indicated that additional input was required.

The Care Quality Commission is required to monitor the operations of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Staff had some knowledge of the MCA and DoLS. The principles of the MCA had not always been followed when decisions had been made on behalf of people who could not make them for themselves.

The registered manager demonstrated good leadership and was very knowledgeable about the people being supported at the service. Effective systems were in place to monitor the quality and safety of the care provided to people, action plans were in place where necessary. Staff were well supported by the registered manager.

We found the home was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We were unable to speak fully with people who lived at the home because they had complex needs that limited their communication. We used observation to assess if they were offered opportunities to a make choice and decide. We spoke with relatives who told us that staff consulted them and respected and acted on the decisions they made about the care and support their relative received.

Our observations showed us that people were given the support and attention they needed and had a positive experience of being included in conversations and decision making. We saw that people were offered daily activities that stimulated and interested them.

We found that plans of care contained the information staff members needed to ensure that the health and safety of people was promoted.

Relatives told us that people living in the home received the care and support they needed and that staff were excellent.

Medication was administered and recorded accurately. We found that the room that the medication was stored in was too hot and that there was a risk that medication was not stored safely. We saw that the provider was taking action to correct this situation.

Adequate numbers of staff members were provided to ensure that the care and support needs of each person were met.

Relatives told us that they had no complaints and that their wishes were listened to and adhered to. We found that there was a complaints system in place that met the needs of people living in and visiting the home.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant that they were not able to tell us their experiences.

We spoke with relatives of people living in the home. They told us that the needs of their relative were met and that they were consulted about the care and support that their relative was provided with. They were complimentary about the staff that cared for their relative and told us that they always treated them and their relative with respect and kindness. They told us that the privacy of their relative was respected and that their relative was provided with enough staff to assist and support them. They told us that the environment was comfortable and clean and that their relative was provided with opportunities to take part in daily individual, group and community activities.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk. We observed that people living in the home were given the support and attention they needed, were appropriately supported to be as independent as possible and had a positive experience of being included in conversations, activities and decision making.