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

This inspection took place on 31 January 2016 and was unannounced. At our last inspections on 24 November and 6 December 2015 we found continued breaches of regulations in relation to safe care and treatment, safeguarding and good governance. We served warning notices for these three continued breaches and asked the provider to make the necessary improvements by 18 January 2016. A warning notice is a formal way of saying to the provider that they were not meeting legal requirements and they needed to make improvements by a set date. At the last inspection we found a breach in relation to staffing which was too early for us to follow-up at this inspection. We will review this at our next inspection of the service.

Woodbury provides accommodation and personal care for up to 15 people with a range of learning disabilities, autistic spectrum disorders as well as physical disabilities. On the day of our visit there were 14 people living in the home.

There was no 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. The registered manager left in March 2015. The provider has appointed an acting manager whilst they undertook recruitment for a new permanent manager for the home.

We found that the provider had made all the necessary improvements to address the deficits we identified at our last inspection and so had met the requirements of the warning notices.

The provider had improved the way risks to people were managed. They had consulted with relevant healthcare professionals to ensure risks relating to moving and handling and pressure ulcers were assessed and addressed with suitable management plans in place. The provider had identified those people at risk of developing pressure ulcers and referred them for support from the district nurse who visited them regularly. Staff had attended refresher training in moving and handling and the provider had trained one staff to be the service’s ‘expert’ on moving and handling to support staff improve their practice. Training for staff on supporting people at risk from pressure ulcers was arranged for February 2016. The provider carried out checks that a person’s pressure relieving mattress was used correctly to reduce their risk of pressure ulcers. In addition the provider had consulted with a healthcare professional to ensure a person’s mattress was safe for use with their particular bed rails, so they could continue to use these items of equipment.

The provider had strengthened procedures for staff to record and report any injuries to people such as bruises or other wounds. Management investigated such injuries to check how they occurred and whether they were the result of abuse. Staff had also attended refresher training in safeguarding since we raised concerns at our last inspection.

The provider had improved the way they monitored, assessed and improved the quality of the service as well as record keeping systems.

This inspection took place on 24 November and 6 December 2015 and was unannounced. At our last inspection on 8 and 20 April 2015 we found the provider was breaching regulations relating to safe care and treatment, safeguarding, staff training and supervision, and good governance. After that inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. As part of this comprehensive inspection we checked whether the provider was now meeting these legal requirements.

Woodbury provides accommodation and personal care for up to 15 people with a range of learning disabilities, autistic spectrum disorders as well as physical disabilities. On the day of our visit there were 13 people living in the home.

There was no registered manager in post. The registered manager had left in March 2015 and a new manager was recruited shortly after. However, they had also left the service just over a week before our inspection. An acting 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.

We found that the provider has not made all the necessary improvements to address the deficits we identified at our last inspection.

They continued to manage some risks to people poorly. These risks related to moving and handling, the prevention of pressure ulcers and bed rails. We found that risk assessments were not always carried out to assess risks to people and these were not always kept up to date with current information. Suitable risks management plans to guide staff were also not available.

People were still not safeguarded from abuse. Although staff recorded bruises and other wounds on body maps appropriately these were not investigated by management to check how they occurred so they could take appropriate action to prevent these from happening again.

There was insufficient numbers of staff deployed on shift to meet people’s needs. The provider’s recruitment campaign to fill vacancies continued.

The auditing systems in place remained ineffective in identifying the breaches of regulations we found during this inspection. In addition, records in relation to the management of the service were not always well maintained.

Medicines management was safe and our checks indicated people received their medicines as prescribed. The medicines policy had been updated to include how ‘homely remedies’, medicines purchased over the counter, should be administered safely. Staff carried out daily audits of medicines to check people had received their medicines appropriately.

Recruitment was safe and the provider had introduced checks of people’s mental and physical health to carry out their roles as required by law. Other checks on staff were carried out such as checks of criminal records, references from previous employment and employment histories, proof of identification and right to work in the UK. The provider had audited staff recruitment folders and identified some gaps and they were gathering the required information from head office or from staff to keep at the service.

The premises were safe because regular checks were carried out both internally and by external contractors. A maintenance team was in place to carry out day to day repairs which were requested and carried out promptly.

Staff received support to carry out their roles through supervision and a suitable training programme.

People received choice of food and drink and received food in sufficient quantities. People also received the right support to eat and drink and their nutritional status was monitored by staff through regular weighing where necessary. Staff supported people to access health services in order to remain healthy.

Staff understood their responsibilities in terms of obtaining consent from people and supporting them under the Mental Capacity Act 2005. The service was also meeting their requirements under the Deprivation of Liberty Safeguards (DoLS). These safeguards are there to help make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom.

Staff treated people with kindness, dignity and respect in their day to day interactions with them. Information about people’s preferences and backgrounds was recorded and people were involved in developing their care plans. Staff supported people to be as independent as they wanted to be.

A suitable complaints system was in place and relatives told us they were confident in how the provider would respond if they raised concerns with them.

People had individual activity programmes in place based on their interest and a range of activities were offered to people both inside and outside the home.

At this inspection we identified three continued breaches of regulations. These were in relation to safe care and treatment, safeguarding people and good governance. We are taking action against the provider in relation to these breaches and will report on this when our actions are completed. We also identified a new breach of regulation in relation to staffing. You can see the action we told the provider to take at the back of the full version of this report.