We carried out an unannounced inspection of 12 Woodland Road on 10 May 2018.

12 Woodland Road is a residential care home registered to accommodate four people who have a learning disability. It is managed and operated by MacIntyre Care. The service operates from a dormer bungalow located in a residential area of Ellesmere Port close to local shops and transport links. At the time of our visit, three people were living there.

At our last inspection in November 2015 we rated the service as good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection or ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People could not verbally tell us about the quality of the support they received. People appeared relaxed and comfortable with staff at all times and the support staff provided was centred entirely on the needs of individuals. The registered provider had introduced communication plans which outlined in detail what each type of non-verbal communication expressed by people meant and how it must be responded to.

Staff had had received training in how to protect vulnerable adults and were clear about how they could report any allegations of abuse. They were also clear about the agencies they could speak to if they had concerns about poor practice within the service.

The premises were well maintained, clean and hygienic. Equipment such as hoists, portable electrical appliances and fire extinguishers were regularly serviced to ensure that they were safe. Risk assessments were in place identifying any potential hazards within the environment that could pose a risk to people and how this risk could be prevented. Personal evacuation plans were also in place to ensure the safe evacuation of people in the event of a crisis.

Assessments were in place highlighting the risks people faced from health issues such as weight loss and malnutrition as well as risks which reflected their vulnerability. These were closely monitored and reviewed regularly.

Sufficient staff were on duty at all times of the day. Staff were always available to attend to people’s needs. Staff rotas were available to confirm that there were sufficient staff on duty at all times. Staff recruitment was robust with checks in place to ensure that new members of staff were suitable people to support vulnerable adults.

Medication management was robust and promoted the well-being and safety of people who used the service. Checks were in place to ensure that medication was given when needed and systems in place to ensure that supplies never ran out. Staff who administered medication received appropriate training and had their competency checked.

Staff received training appropriate to their role. Staff received supervision to ensure that they were aware of their progress and to discuss any needs they had. Group supervision in the form of staff meetings also took place.

The registered provider had taken the requirements of the Mental Capacity Act into account. This included assessments on the degree of capacity people had, how limited capacity would impact on their daily lives and how decisions could be made in their best interest. Staff had received training in the Mental Capacity Act and understood the principles associated with it.

The nutritional needs of people were met. Meals were prepared in a clean and hygienic kitchen. Food stocks were sufficient and staff were aware of the nutritional needs of people and the considerations in supporting them to eat and drink.

Staff provided a caring, inclusive and person centred approach in the way they delivered support to people. They took the privacy and dignity of people into account through practical arrangements such as knocking on doors and in the manner they interacted with people.

Peo

This was an unannounced inspection, carried out on 26 November 2015.

Woodland Road is a residential care service which provides care and support to a maximum of four people with a learning disability. The service operates from a dormer bungalow located in a residential area of Ellesmere Port close to local shops and transport links. At the time of our inspection there were four people living at the service.

The service has a registered manager. 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 is currently away from the service and an interim manager is responsible for the day to day running of the service.

We last inspected this location in May 2014 and we found that the registered provider met all the regulations we reviewed.

People received care and support that kept them safe and staff understood what is meant by abuse and were aware of the different types of abuse. The care staff knew how to identify if a person may be at risk of harm and the action to take if they had concerns about a person’s safety. Staff told us they would not hesitate to raise concerns and they felt confident that they would be dealt with appropriately. Family members raised no concerns about their relative’s safety.

The registered provider used safe recruitment systems to ensure that new staff who were suitable to work in people’s homes were employed.

People received their medication as prescribed and staff had completed competency training in the administration and management of medication. Medication administration records (MAR) were appropriately signed and coded when medication was given.

Policies and procedures were in place to guide staff in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Staff had a good knowledge and understanding of the Mental Capacity Act 2005 and their role and responsibilities linked to this. Training had been completed in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) and staff were able to show an understanding of the key principles when asked.

Care staff knew the people they were supporting and the choices they had made about their care and their lives. People who used the service, and those who were important to them, were included in planning and agreeing to the care provided. The decisions people made were respected. People received care from a team of staff who they knew and who knew them. People were treated with kindness and respect.

There were sufficient staff, with appropriate experience, training and skills to meet people’s needs. Staff were well supported through a system of induction, training, supervision and professional development. There was a positive culture within the service which was demonstrated by the attitudes of staff when we spoke with them and their approach to supporting people to maintain their independence.

People’s needs were assessed and planned for and staff had information about how to meet people’s needs. People’s wishes and preferences and their preferred method of communication were reflected in the care plans. Care plans we reviewed were personalised and reviews always promoted the involvement of the person or other important people such as family members. Staff worked well with external health and social care professionals to make sure people received the care and support they needed.

There was a robust quality assurance process in place. This meant that aspects of the service were formally monitored to ensure good care was provided and planned improvements and changes were implemented in a timely manner. There were good systems in place for care staff or others to raise any concerns with the registered manager.

The service was well-led by a person described as supportive, approachable and diplomatic. Systems were in place to check on the quality of the service. Records were regularly completed in line with the registered provider’s own timescales. We were notified as required about incidents and events which had occurred at the service.

The service was hygienic and clean.

Our inspection team was made up of one inspector. They looked at our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

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

Is the service safe?

We saw that staff treated people who used the service with respect. We noted that the needs of people were addressed at all times. One person was unwell during our visit and we noted that staff ensured that the person was comfortable and was provided with everything that they needed at the time. Although people who lived at Woodland Road had limited verbal communication, we saw that they appeared relaxed and comfortable with the staff team.

Is the service effective?

There was an advocacy service available if people needed it, this meant that when required people could access additional support.

People’s health and care needs were assessed on a regular basis, and while people had limited verbal communication, people involved in their care where involved in the reviewing of their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required

People’s needs were taken into account with care plans outlined in pictorial form and other information presented in the same way. Work within the premises had included the refurbishment of a sensory room designed to further enable people to feel comfortable and relaxed.

Is the service caring?

Our observations noted that staff were attentive to the needs of the people and that their work focussed exclusively on the needs of people. People were not able to tell us about their experiences of the support they received yet we were able to tell from non-verbal communication that they felt at ease and happy with the staff team. We saw comments from one family member who stated; “The staff are a great group of people and they are relaxed and dedicated to getting it right for my sister. We are fortunate that she lives in such a caring place”

Is the service responsive?

The service had a Quality Assurance processes in place which sought the views of people involved in the support of people living at Woodland Road. When issues had been identified for improvement, they were dealt with promptly. Where changes to the overall care of people had occurred, we saw evidence that families had been informed of these. Staff considered that they were listened to by the provider. We saw evidence in health records demonstrated that as soon as new health conditions arose, the staff team ensured that people received prompt referral to medical agencies. We also saw evidence through care plans that as needs changed; plans were amended and reviewed on a regular basis.

Is the service well-led?

The service had a manager who was registered with us to carry out their roles. We noted that the service always told us when there were significant incidents. The service remained part of a larger organisation which had systems in place to ensure that people received a person centred level of support. We saw evidence in care plans that the service worked with other agencies to ensure positive outcomes for people.

You can see our judgements on the front page of this report.

Our last visit to Woodland Road had found that the service was non compliant in the areas of maintaining the care and welfare of people as well as the management of medication. This unannounced follow up visit was made in order to check action taken by the provider to achieve compliance in these areas.

We looked at four care plans and one risk assessment. We found that work had been completed to ensure that the care and welfare of people had been promoted. We also looked at medication guidelines in relation to PRN medication which relates to medication given to people when needed. Again we found that medication procedures had been improved to promote people's health and wellbeing. We held discussions with staff who confirmed that work had been completed to achieve compliance and they felt that more continuity of care had been achieved.

We were introduced to one person living at Woodland Road. This person had limited verbal communication yet they appeared relaxed and interacted with staff in a positive and friendly manner. Staff were able to spend time with this person supporting them on a one to one basis and we observed that this person responded well to this.

As a result, the service is now compliant with all outcome areas.

We used different methods to help us understand the experiences of people who used the service. This was because the people living at 12 Woodland Road had complex needs which meant they were not able to tell us their experiences. We spoke with relatives who told us they were happy with the service offered to their family members. One comment made was; “If we had to personally interview and employ staff to look after our relative we would choose the staff at Woodland Road. They are exceptional people and we are so glad we found them.”

We looked at how the service assessed the needs of people prior to them moving into the service. Records showed the needs of people already using the service had not been taken into consideration in a meaningful way prior to an offer of a placement being made. Records also showed the negative impact of certain behaviours on people had not been documented in their support plans and risk assessments. This meant people may not have received appropriate support.

Information provided after the inspection visit showed that staff received training around the protection of vulnerable adults. Records showed medication was not always administered appropriately.

There was a system in place to encourage the staff team to support people who used the service to raise issues or complaints on their behalf. Relatives spoken with told us they felt involved in the support and care provided to their family members and felt they were listened to.

The nature of the disability of people living at Woodland Road is such that it is not always possible to gain their views verbally. We did note that people there seemed comfortable and at ease with the staff team during our visit. We were able to view surveys recently completed by family members that provided positive comments about the care and support provided.

We did invite other family members to contact us to provide their experiences of Woodland Road. No comments were received at the time of writing this report although any comments we do receive subsequently will be used as part of our ongoing assessment of the service.