This inspection took place on 7 June 2017 and was unannounced. This meant the staff and provider did not know we would be visiting.

Woodham Grange provides care and accommodation for up to eight people with a learning disability. On the day of our inspection there were seven people using the service. The home had a spare room for people who stayed at Woodham Grange for respite care.

The service did not have a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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 previous registered manager had recently left the service. A new manager was in place who had applied to CQC to become registered.

We last inspected the service in 2015 and rated the service as ‘Good.’ At this inspection we found the service remained ‘Good’.

Accidents and incidents were appropriately recorded and risk assessments were in place. The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

The provider had an infection prevention and control policy and procedure in place and an annual statement was produced outlining the service’s systems for the prevention and control of infection.

The home was clean, spacious and suitable for the people who used the service and appropriate health and safety checks had been carried out.

Appropriate arrangements were in place for the safe administration and storage of medicines.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff.

Staff were suitably trained and received regular supervisions and appraisals.

The provider was working within the principles of the Mental Capacity Act 2005 (MCA) and was following the requirements in the Deprivation of Liberty Safeguards (DoLS).

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of visits to and from external health care specialists.

Family members were generally complimentary about the standard of care at Woodham Grange.

Staff treated people with dignity and respect and helped to maintain people’s independence where possible. Care plans were in place that recorded people’s plans and wishes for their end of life care.

Care records showed that people’s needs were assessed before they started using the service and care plans were written in a person-centred way. Person-centred is about ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs.

The provider had an effective complaints procedure in place.

Staff felt supported by the management team and were comfortable raising any concerns. The provider had appropriate auditing processes in place and people who used the service, family members and staff were regularly consulted about the quality of the service.

Some statutory notifications were submitted in a timely manner however six statutory notifications for DoLS authorisations had not been submitted to CQC. We are dealing with this matter outside the inspection process.

We carried out this focused inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We carried out an unannounced focused inspection of this service on 20 July 2015. A breach of legal requirements was found following the comprehensive inspection on 6 April 2015, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now meet legal requirements. This report only covers our findings in relation to this requirement. At the last inspection on 6 April 2015, we asked the provider to take action to make improvements. We asked the provider to refurbish the kitchen, and this action has now been completed.

The inspection was led by an adult social care inspector.

The service had 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.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk

During our inspection we asked the provider, staff specific questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions, as mentioned above.

Below is a summary of what we found. The summary is based on our observations during the inspection, observing how people using the service were supported, and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service had very complex physical and learning disability support needs. Not all were able to communicate verbally. However, we observed people to be comfortable in the presence of the staff team. We saw that staff used various and effective communication techniques to communicate with people. We saw and observed lots of positive interactions with staff and people who used the service.

We saw the provider had a rigorous training programme in place for staff. The staff training and observations helped to ensure people living in the home were appropriately supported and protected from harm.

People who lived in the home had regular assessments carried out and an annual review with their care managers. This ensured peoples care and support needs were current, effective, safe and protected their rights.

Is the service effective?

We saw people who used the service and other professionals were involved with the planning of their care and the level of assistance they wanted wherever possible.

People’s care plans were individual and person centred, detailing individuals likes and dislikes, preferences and religious beliefs.

People who lived at the home were given access to specialist health care professionals including, occupational therapists , opticians, and physiotherapist's to help ensure their wider health needs were being met.

Is the service caring?

People who received help with personal care were treated kindly and with respect. People smiled a lot were seemed happy and relaxed with the care staff and we saw their preferences being taken into account. For example, what they wanted to do during the day, and where they wanted to go to on holiday. Two people had just returned from a week’s holiday in Kielder Forrest. Others were planning a holiday to Blackpool.

Is the service responsive?

People who used the service, their family, friends and other professionals who worked with them were regularly asked for their views on the way the service was run. Responses to surveys were analysed and used to enable the manager to make changes to the service where needed.

Is the service well lead?

The staff working at the home told us they felt supported in their roles and were happy with the level of training they received. Staff were confident that any concerns or complaints they may have would be dealt with quickly, appropriately and in confidence.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

Our inspection of June 2013 we found people's care plans did not fully reflect their current care needs. This was because some plans had not been completed or updated on a regular basis to keep people safe. Following this inspection we asked the provider to send us an action plan detailing how improvements would be made. The action plan we received told us there were procedures in place to review all people’s care and support plans. Where possible, people who used the service and their representatives had been involved with the review, planning and decision making of their care and support needs.

During this inspection we looked at three people’s care records in detail. We found people's health and care needs had been fully assessed. We saw specialist dietary, mobility and equipment needs had been identified in care plans when required. We found people's current care and support needs were reflected in their care plans and these were evaluated and updated each month or more frequently where necessary.

People’s needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people.

All seven people living in the home found it difficult to express their experiences of living there due to their physical or learning disability.

The home was in the process of recruiting a registered manager at the time of the inspection and was temporarily filling the post with senior staff at the home.

We found the home to be clean and tidy and the people living there appeared happy and content.

People living at Woodham Grange had their own way to communicate, which staff had recorded on care records; for example facial expressions, or gestures. At lunch time we saw staff supporting people using these techniques and also helping people to remain as independent as possible.

We found that staff were using older care records and some risk assessments had not been reviewed for over a year.

We spoke to two relatives at the visit and one relative said, “I cannot find a fault, staff are good”. They also said, “They are regularly taken out on the bus and have a better social life than me”. ‘They’ meaning the person living in the home.

We found appropriate arrangements in place to manage people’s medicines.

We looked at staff records at the home and found that staff were suitably qualified, skilled and experienced to be able to care and support people living at Woodham Grange.

We found complaints procedures in place at the home and when we asked relatives if they knew how to complain they said, “I would speak to the manager or Durham county council”.

The provider had a Statement of Purpose and Service Users Guide.

Pre admission assessments were carried out for all prospective people who were considering using the service. On the day of our inspection the home had one vacancy.

Health and personal care plans seen were recorded to a good standard and health care records were fully completed.

Staff were observed to have respect for people's privacy.

We saw there were a range of activities organised by staff, including regular trips out of the home and indoor activities.

The home had a detailed adult protection procedure. Systems were in place for the reporting concerns and abuse.

The home was well maintained. Some areas of the home had recently been redecorated and a maintenance plan was in operation.

The area manager and a director of the company told us a minimum of four staff would continue to be in place across the day.

A staff training plan was in place, which identified how staff would be trained to the required levels. Staff received formal supervision sessions and an annual appraisal.

Health and Safety systems were in place and the manager said all the equipment including alarm systems and nurse call systems had been checked by approved contractors.

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 they were not able to tell us their experiences. We spoke with staff, observed people and care practices, and looked at care records.

We saw people had their own style of communication, for example body language, facial expressions, gestures and signs which staff understood and responded to.

We saw people were given time to express their needs and were involved in making day to day decisions. People were supported in a way which was mindful of their right to respect, dignity and privacy. People appeared relaxed, content and at ease in their surroundings.

This inspection took place on 7 and 9 April 2015 and was unannounced. Woodham Grange provides care and accommodation for up to eight people with complex physical and learning disability support needs. On the day of our inspection there were a total of seven people using the service.

The home had 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 and associated Regulations about how the service is run.

During our inspection at Woodham Grange there was a very calm and relaxed atmosphere in the home and we saw staff Interacted with people in a friendly and respectful manner. People who used the service were unable to verbally communicate with us; however all appeared happy and relaxed with the staff on duty. We saw that the staff communicated with people who used the service effectively and in a caring way. We saw the staff understood people’s needs through signs, gestures and facial expressions. Two people’s family members described their relatives care as, “excellent.”

Staff and a visitor we spoke with described the management of the home as open and approachable.

Throughout both days we saw that people were comfortable and relaxed with the staff and the registered manager on duty. For example reaching out to hold staff hands, embracing staff with lots of smiling.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) is part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. We discussed DoLS with the provider and looked at records. We found the provider was following the requirements of DoLS.

Staff we spoke with said they had received appropriate training. We saw records to support this. Staff had also received training in how to recognise and report abuse. We spoke with eight staff and all were clear about how to report any concerns. Staff said they were confident that any allegations made would be fully investigated to ensure people were protected.

Throughout the inspection we saw staff interacting with people in a caring and professional way. We saw a member of staff supporting one person with their mobility. They were interacting happily and laughing together. We saw another two staff assisting a person after having a bath. The person being assisted and both staff were singing which the person was clearly enjoying. We noted that throughout the inspection when staff offered support to people they always respected their wishes and described what how they were going to support them. We saw people smiling and happily engaging with staff when they were approached.

We saw there was a weekly activity programme and records showed that people were able to take part in group activities or on a one to one basis. We saw activities were personalised and there were very regular outings and holidays planned.

We saw people were treated with respect and privacy was upheld.

People received a wholesome and balanced diet and at times convenient to them.

We saw the provider had policies and procedures for dealing with medicines and these were adhered to.

The provider had an effective pictorial complaints procedure which people and their representatives were able to use. We saw all people who used the service had an independent advocate who could act in their best interests.

We saw people who used the service were supported and protected by the provider’s recruitment policy and practices.

The home was clean and equipment used was regularly serviced.

The provider had a quality assurance system, based on seeking the views of people, their relatives and other health and social care professionals. There was a systematic cycle of planning, action and review, reflecting aims and outcomes for people who used the service.

Staff told us they received regular supervision. We saw records to support this.

The kitchen units and worktops were worn chipped and scorched and posed a hazard.

People who used services and others were not protected against the risks associated with unsafe or unsuitable premises because of inadequate maintenance.

This is a breach of Regulation 15.

You can see what action we have asked the provider to take at the back of this inspection report.