About the service:

Woodland Grove is a ‘care service’ People in care services receive accommodation and nursing or personal care. CQC rates both the premises and the care provided, and both were looked at during this inspection. Woodland Grove accommodates up to 10 people with a learning disability. At the time of our inspection there were six people living at the service.

People’s experience of using this service:

We carried out an unannounced targeted inspection of this service in September 2018 where we found improvements had been made since the full comprehensive inspection which was carried out in April 2018. At this inspection we found that the service has consistently improved in areas of concern and they have taken on the comments made at previous inspections and put actions in place to improve the quality of the service and make it safe for people to live.

The management has changed and there is now a dedicated service manager as well as a registered manager. This has improved support for the staff team which has in turn improved the care and support for the people using the service.

The cleanliness of the service has improved significantly, having all bath and shower rooms refurbished with materials which are easier to keep clean and free from infection. New processes for cleaning and monitoring the cleanliness of the service are now in place and there were no malodours.

The people we spoke to told us that Woodlands Grove is a good place to live. We observed people being treated with kindness, dignity and respect. Relatives told us that they had confidence in the service and that improvements had been made since Lifeways had taken over the service.

Peoples health and social care needs were managed well by the management and the staff team. Needs were identified at an assessment and plans put in place on how to best provide care and support tailored to meet those needs. Support plans were being improved to ensure that they were a working document and the information was accessible and useful for the staff.

People participated in a range of activities that met individual choices and preferences. Staff understood the importance of this for people and provided structured support people required. This enabled people to achieve positive outcomes and promoted a good quality of life.

Rating at last inspection: At the last inspection in October 2018 we found two breaches of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014.The service was rated requires improvement in the Safe and Well led domains and the overall rating was requires improvement.

Why we inspected: This was a planned inspection based on the rating at the last inspection. We saw significant improvements since our last inspection. There was a new management structure including a registered manager and a dedicated service manager. Improvements had also been made to the building which improved the safe domain.

Follow up: We will continue to monitor this service and any intelligence we receive until we return to inspect under our inspection programme.

We conducted an unannounced inspection at Woodland Grove on 6 September 2018. Woodland Grove is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Woodland Grove accommodates up to 10 people in one building. On the day of our inspection, seven people were living at the home; all of these were people with a learning disability.

We carried out an unannounced comprehensive inspection of this service on 23 April 2018. Breaches of legal requirements were found. After the comprehensive inspection, we served warning notices on the provider in relation to the cleanliness of the environment and the leadership and governance of the home. The warning notices required the provider to become compliant with the legal regulations within specified timescales.

We undertook this focused inspection to check the provider had made improvements needed to meet the legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Woodland Grove on our website at www.cqc.org.uk.

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.

At this inspection, we found some improvements had been made to the cleanliness of the home, there was no longer a breach of the legal requirements in this area. However, further work was needed to promote consistently good hygiene and to control and prevent the spread of infection. Safe food hygiene practices were not always followed. There were systems in place to protect people from abuse and improper treatment. However, during our inspection we received some concerns which we shared with the registered manager and local authority safeguarding adults team. These remained under investigation at the time of writing this report.

Since our last inspection, action had been taken to ensure people were protected from risks associated with their care and support. Risk management was balanced with enabling people’s independence. Staff had a good understanding of how to support people whose behaviour could place them and others at risk and people were supported in the least restrictive way possible. There were enough staff to meet people’s needs and ensure their safety. Safe recruitment practices were followed. Some improvements were required to ensure medicines records were fully completed, but overall, we found people received their medicines as prescribed.

Improvements had been made to quality assurance and audit systems. However, these systems were still not fully effective in ensuring issues were identified and addressed in a timely manner. Work was underway to better involve people who used the service and their families in the running of the home. Further improvements were needed to explore accessible ways of involving people in this. Overall, staff felt supported and were positive about improvements made at Woodland Grove. The registered manager kept up to date with best practice and had good relationships with external health professionals. They took swift action to investigate and address concerns identified during this inspection.

We conducted an unannounced inspection at Woodland Grove on 23 April 2018. Woodland Grove is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Woodland Grove accommodates up to 10 people in one building. On the day of our inspection, seven people were living at the home; all of these were people with a learning disability. This was the first time we had inspected the service since they registered with us.

There was no registered manager in place at the time of our inspection. The previous registered manager had left Woodland Grove in November 2017. 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. There was a service manager in post at the time of our inspection and they informed us they would be submitting an application to register with CQC. We will monitor this.

During this inspection, we found action had not always been taken to protect people from risks associated with their care and support. Support provided to people whose behaviour could pose a risk to themselves and others was inconsistent; work was underway to improve this. There were not enough staff to meet people’s needs at all times. The environment was not clean and hygienic and effective infection control and prevention measures were not in place. Environmental risks were not always safely managed. There were systems and processes in place to minimise the risk of abuse. Safe recruitment practices were followed. Overall, medicines were managed safely. However, some improvements were required to ensure medicines were stored safely.

People were not supported to have maximum choice and control of their lives and were not supported in the least restrictive way possible; the policies and systems in the service did not support this practice. People’s day-to-day health needs were met. However, there was a risk that people may not receive the support they needed with specific health conditions as support plans lacked detail. Care and support was planned and co-ordinated when people moved between different services. Overall, people had enough to eat and drink. Further improvements were needed to ensure food was available and stored safely. Staff did not receive sufficient training to enable them to effectively meet people’s individual needs and staff did not receive regular supervision and support.

People told us staff were kind and caring. However, people were not always treated in a respectful and dignified manner and were not involved in choices and decisions. Most staff knew people well and understood their needs and preferences; however, high turnover of staff and use of temporary staff made it hard for people to develop relationships with them. People had access to advocacy if they required to help them express their views.

Overall, staff had a good knowledge of people’s support needs. However, some improvements were required to support plans to ensure people received consistent support. Overall, people’s diverse needs were recognised and accommodated and they were provided with the opportunity to discuss their end of life wishes. People were offered some opportunities to take part in social activities. However, these were limited, inconsistent and adversely affected by staffing levels. People were supported to maintain relationships with people who were important to them. There were systems in place to respond to concerns and complaints.

A lack of consistent, effective leadership at Woodland Grove had a negative impact upon the quality of the care at the home. Systems to ensure the safety