Wood House is a residential care home for up to 16 people with learning difficulties. At the time of our inspection, 15 people were living in the home.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

People were protected because there were risk assessments in place to guide staff in providing safe support. Staff had been trained in safeguarding vulnerable adults and were confident about reporting any concerns. People were supported to receive their medicines safely.

People were supported to see healthcare professionals when they needed to. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People’s nutritional needs were monitored. Staff were trained and supported to carry out their roles.

The service was caring. People were able to be involved in the running of the home through a service user forum. We observed staff interacting with people in the home in a kind and caring manner.

The service was responsive. There was a procedure in place to manage complaints so that people could be assured their concerns would be listened to. People were given opportunity to engage in activities if they wished to.

There were systems in place to monitor the quality and safety of the service provided. Staff generally felt well supported and told us staff worked well as a team.

Further information is in the detailed findings below

This inspection took place on 22 January and was unannounced. The service was previously inspected in September 2013 and there were no breaches of regulations found at this time.

Woodhouse provides personal care and accommodation for up to 16 people with a learning disability. At the time of our inspection there were 14 people living in the home.

There was a registered manager in place at the time of our inspection. 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.’

People received effective care; however we found that improvements could be made. Staff were inconsistent in how they used visual materials to support their communication with people, particularly when offering choices.

People in the home were safe. Staff were trained in recognising the signs of potential abuse and told us they felt confident in doing so. They were aware of where to locate policies and procedures for reporting concerns if they needed to. People weren’t able to speak with us about their experiences of living in the home; however we observed that people appeared settled and content in the presence of staff.

There were individual risk assessments in place to guide staff in providing care in a safe way. Other checks ensured that risks associated with the building were managed. This included fire safety.

There were systems in place to support people safely with their medicines. Medicines were stored securely and stock checks were taken regularly to help ensure that any discrepancies would be identified and investigated. Any unused or out of date medicines were disposed of safely by being returned to the pharmacy.

There was sufficient staff to meet people’s needs. Our observations showed that care was delivered in a calm and unrushed manner. People’s needs were met and there was sufficient numbers of staff to accompany people to go out in the local community.

People were supported to see other healthcare professionals when needed. We saw that people’s GPs were contacted when concerns were identified about their health.

Staff were aware of and adhered to the principles of the Mental Capacity Act 2005. When a person lacked the capacity to make a decision about their care or treatment, processes were followed to ensure that a decision was made in their best interests. Where necessary, this included involving an IMCA (Independent Mental Capacity Advocate).

People’s nutritional needs were met. Staff responsible for meal preparation had clear guidelines in place about people’s individual dietary needs and preferences. Particular requirements such as a lactose free diet were catered for.

Staff treated people in a kind and caring way. One relative told us that they "couldn’t fault" the service. Staff were aware of the importance of treating people with dignity and respect and encouraged people to be independent where possible. People were encouraged to express their views and opinions about the care they received. The views of relatives and representatives were listened to.

The service was responsive to people’s individual needs. Staffs were knowledgeable about the people they supported and valued people as individuals. Support plans were evaluated regularly to ensure that they were current and updated if a person’s needs changed.

There had been no formal complaints in the last 12 months that had required investigation. However, there was complaints procedure in place and people were given information about how to raise concerns in a format that met their needs.

The service was well led. There were systems in place to monitor the quality and safety of the service. Any shortfalls identified as part of the monitoring was shared with staff so that all were aware of the improvements required. The registered manager was supported by the organisation to make improvements to the home. This included building a sensory room for people to use. A sensory room is a special room designed to develop people's senses, through special lighting, music, and objects.

People who used the service were not able to talk to us directly about the care and support that they received. However we made observations, spoke with four members of support staff and also the relatives of one person who lived in the home. We received positive feedback from the relatives that we spoke with. They told us that staff were "very caring", and that the home was the best one that their relative had lived in.

We viewed the care records of four people who lived in the home and saw that these gave staff clear information about their needs. Risk assessments were in place to ensure that people were cared for safely. We observed people being treated respectfully and spoken to in an appropriate tone by staff.

People's nutritional needs were met because they received meals according to their identified needs. Professional guidelines were in place and staff were made aware of these.

We heard that staff levels had improved recently so that there was less reliance on agency staff to fill shifts. We viewed staffing rotas and these confirmed that expected staffing levels were met. Where necessary, bank staff were used to cover shifts and this helped ensure continuity of care for people in the home.

There were systems in place to monitor the quality and safety of the service provided.

We found that improvements had been made since our last inspection of the home.

People were able to make decisions in their daily lives. One person, for example, told us that they could choose where to eat their meals. We found that staff had a better understanding of ‘consent’ and when people would need support with making decisions about their care and treatment.

We found that staff had knowledge about people’s needs in areas such as pressure area care, diet and mobility. Health professionals had been involved in producing guidelines which helped to ensure that staff supported people safely. Some people had a special diet and required assistance with eating; at lunch time we observed people receiving support in an appropriate and careful manner. One person told us that they had a diabetic diet and that they enjoyed the meals.

We found that the number of harmful incidents between people at the home had reduced. Staff told us that training in the subject of ‘self-harm’ had been arranged and that they had found this useful.

Staff said that there had been a lot of training since the last inspection. We found that there was a more planned approach to staff training and a programme of specialist training had been implemented. Overall we found that people were benefiting from some recent developments in the home. Staff felt supported in their work although they were looking forward to a period of stability in the management of the service.

The people at Woodhouse had a range of needs relating to their learning disabilities. Some people also had a physical disability. We met with a number of people who used the service although not everyone was able to tell us about their experience of the home. We talked with staff and looked at the arrangements being made in the home to help us make judgements about the service.

People could make some decisions and choices in their daily lives. A number of people went out on shopping trips on the day we visited. People said they had talked to staff about where they wanted to go. However there was a lack of information about people’s capacity to make informed decisions. This meant there was a risk that people’s best interests were not being met.

People received support from staff so that their healthcare needs were met. However more needed to be done to make sure that people’s care and support were well planned. This was to ensure that people were safe and to reduce the risk of individuals being harmed.

The home was without a permanent manager at the time of our visit. Procedures were in place for supporting staff and monitoring the quality of the service, although these had not been always been well managed and consistently implemented.

We spoke to three people living in the home in different areas of the home.

Some people were seen relaxing in a communal area with their support workers while others were in their 'apartment' or their 'flat.' We saw some people listening to music and they told us that they they liked their music.

One person said “I am getting used to Woodhouse” and told us about some of the choices they made about their meals.

We were told: “I go to Bingo and hydro." (a swimming therapy)

People told us that staff helped them with the different activities they were involved with.

Another person told us "I feel safe"

Concerns were raised by the local authority safeguarding lead during June 2011 when they received numerous incidents relating to the culture of the home in that people living at the home were being hit, and were hitting other people living there.

Although this has led to the home not admitting any new people, it has been recognised that significant action has been taken by the home to address issues.